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Effect of clarithromycin in experimental empyema by multidrug-resistant Pseudomonas aeruginosa

Eirini-Charikleia Tsovolou1, Ira-Maria Tzepi, Aikaterini Spyridaki

  • 14th Department of Internal Medicine, Medical School, University of Athens, Athens, Greece.

APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica
|May 10, 2013
PubMed

Insights

Clarithromycin combined with piperacillin/tazobactam significantly reduced bacterial growth and inflammation in experimental empyema. This combination therapy offers enhanced efficacy for treating multidrug-resistant Pseudomonas aeruginosa infections.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Experimental Medicine

Background:

  • Ventilator-associated pneumonia (VAP) treatment can be challenging, particularly with multidrug-resistant pathogens.
  • Intravenous clarithromycin has shown promise in accelerating VAP resolution.
  • Understanding the mechanism of clarithromycin's action is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the synergistic effect of clarithromycin and piperacillin/tazobactam in a rabbit model of empyema.
  • To elucidate the impact of this combination therapy on bacterial load, inflammation, and tissue damage.

Main Methods:

  • An experimental empyema model was established in 40 rabbits using multidrug-resistant Pseudomonas aeruginosa.
  • Animals were randomized into four groups: control, clarithromycin alone, piperacillin/tazobactam alone, and combination therapy.
  • Pleural fluid and tissue samples were analyzed for bacterial culture, apoptosis, tumor necrosis factor-alpha (TNFα) levels, and tissue growth.

Main Results:

  • Combination therapy (clarithromycin + piperacillin/tazobactam) significantly reduced pleural fluid bacterial growth by day 5 compared to monotherapy or control groups.
  • Lung tissue growth was significantly lower in the combination therapy group compared to the control group.
  • Pleural fluid from the combination group showed reduced pro-inflammatory cytokine stimulation (TNFα) in U937 monocyte assays.

Conclusions:

  • Clarithromycin enhances the antimicrobial efficacy of piperacillin/tazobactam against multidrug-resistant Pseudomonas aeruginosa in empyema.
  • The combination therapy effectively reduces bacterial burden and attenuates pro-inflammatory responses, suggesting a beneficial synergistic mechanism.
Keywords:
Pseudomonas aeruginosaclarithromycincytokinesβ-lactams

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